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HHS Public Access
Author manuscript
J Atten Disord. Author manuscript; available in PMC 2022 December 01.
Author Manuscript
Published in final edited form as:
J Atten Disord. 2021 December ; 25(14): 2028–2036. doi:10.1177/1087054720956727.
Changes in Provider Type and Prescription Refills Among
Privately Insured Children and Youth With ADHD
Laura C. Hart1,2, Scott D. Grosse3, Melissa L. Danielson3, Rebecca A. Baum1,2, Alex R.
Kemper1,2
1Nationwide Children’s Hospital, Columbus, OH, USA
2The Ohio State University, Columbus, USA
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3Centers for Disease Control and Prevention, Atlanta, GA, USA
Abstract
Objective: The aim of this paper is to understand associations between age and health care
provider type in medication continuation among transition-aged youth with ADHD.
Method: Using an employer-sponsored insurance claims database, we identified patients with
likely ADHD and receipt of ADHD medications. Among patients who had an outpatient physician
visit at baseline and maintained enrollment at follow-up 3 years later, we evaluated which ones
continued to fill prescriptions for ADHD medications.
Results: Patients who were younger at follow-up more frequently continued medication (77% of
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11–12 year-olds vs. 52% of 19–20 year-olds). Those who saw a pediatric provider at baseline and
follow-up more frequently continued to fill ADHD medication prescriptions than those who saw a
pediatric provider at baseline and non-pediatric providers at follow-up (71% vs. 53% among those
ages 15–16 years at follow-up).
Conclusion: Adolescents and young adults with ADHD who changed from pediatric to
exclusively non-pediatric providers less frequently continued to receive ADHD medications.
Keywords
ADHD treatment; ADHD follow-up; transition to adult care; ADHD
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Article reuse guidelines: sagepub.com/journals-permissions
Corresponding Author: Laura C. Hart, Division of Primary Care Pediatrics, Nationwide Children’s Hospital, 700 Children’s Drive,
Columbus, OH 43205, USA. Laura.Hart@nationwidechildrens.org.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Publisher's Disclaimer: Disclaimer
Publisher's Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the
official position of the Centers for Disease Control and Prevention.
Supplemental Material
Supplemental material for this article is available online.
Hart et al. Page 2
Background
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About half of adolescents with ADHD continue to experience functional impairments from
ADHD symptoms as adults (Sibley et al., 2016). Although continued treatment of ADHD
in adulthood is associated with higher likelihood of employment (Halmøy et al., 2009),
lower risk of being in a motor vehicle accident (Chang et al., 2014), and lower risk of
concurrent substance-related problems (Quinn et al., 2017), many adults with ADHD are
not receiving medication. One study found that only 10% of adults with current ADHD
symptoms were receiving medication for treatment of ADHD (Kessler et al., 2006), and
another found that the prevalence of medication use among adults with ADHD was half of
the estimated prevalence of adult ADHD (Tseregounis et al., 2020). Other studies report that
young adults are less likely than adolescents or children to fill prescriptions for medications
to treat ADHD (Anderson et al., 2018; Johansen et al., 2015; Morkem et al., 2020).
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One of the possible factors contributing to lower ADHD prescription rates among young
adults is the transition to adult care, when young adults navigate a move from pediatric
to adult providers. Relatively few adolescents receive sufficient guidance and planning for
healthcare transition from their pediatric providers (Lebrun-Harris et al., 2018), pediatric
providers report difficulty finding adult providers for their patients with ADHD (Marcer et
al., 2008), and internists report less confidence in diagnosing and managing ADHD (Adler et
al., 2019). The lack of transition preparation for youth, barriers in provider communication,
and lack of training among adult doctors all raise the possibility that adolescents and young
adults may discontinue medication during their transition to adult care.
While adults with ADHD are less likely to fill prescriptions for ADHD medication than
children or adolescents, less is known about when adolescents and young adults stop taking
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medication. Additionally, changing providers may disrupt ADHD medication continuity.
Our aim is to explore associations of age and types of providers seen with continuation of
ADHD medications. Although the present study is descriptive and exploratory in nature, the
ultimate goal of this line of research is to identify modifiable factors to improve outcomes
for young adults with ADHD.
Methods
We used claims data from the IBM® MarketScan® Commercial Databases, which represent
a nationwide convenience sample of claims data from employer-sponsored insurance (ESI)
plans. We accessed MarketScan data via IBM MarketScan Treatment Pathways 4.0, an
online analytic platform using a dynamic version of the data that is stored on IBM Watson
Health™ servers and is restricted to the roughly 75% of enrollees in plans with complete
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data on prescription drugs. Specifically, we accessed the 100% Treatment Pathways sample
of data from January 1, 2011 through July 31, 2018. We restricted our analysis to health
plans from large, nearly all self-insured employers. MarketScan data are deidentified, and
their analysis is classified by the Centers for Disease Control and Prevention (CDC) as
non-human subjects research. All analyses of MarketScan data were conducted by CDC
staff.
J Atten Disord. Author manuscript; available in PMC 2022 December 01.
Hart et al. Page 3
Baseline Population
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To be included in the analytic sample, patients needed to have all of the following occur in
either 2011, 2012, or 2013: continuous enrollment (no more than a 45-day gap in a calendar
year), at least one outpatient visit, at least one claim with an International Classification
of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code for ADHD
(314.xx) in any setting, and at least two filled prescriptions (the second within 180 days of
the first) for an ADHD medication (list in Supplemental Table). Data from these 3 years
were pooled and stratified by 2-year age groups (8–9, 10–11, 12–13, 14–15, and 16–17
years) and are reported as the baseline data.
Physician Visit Definitions
A combination of provider type and setting information within Treatment Pathways was
used to define “physician visits” for this analysis. The possible provider types listed in
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Treatment Pathways are facility, non-admitting physician, admitting physician, surgeon,
physician, other professional (non-physician), and agency. The possible settings include
specialty office visits, primary care provider (PCP) office visits, non-physician office visits,
and other outpatient visits. Any claim that had both a provider type within the five physician
or surgeon categories and a setting of specialty, PCP, or other outpatient was classified as a
physician visit. Any outpatient visits listed under the other professional or agency provider
type were designated as non-physician visits. Physician visits were identified as pediatric
if the provider type was one of the twenty provider types that refer to either pediatrics
in general or pediatric specialties, including child psychiatrists. Claims submitted by a
physician extender billing under a physician’s supervision would generally be classified as
physician visits, with the designation of pediatric or non-pediatric being determined by the
provider type of the physician that the physician extender was billing under.
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For this analysis, all physician visits with a pediatric provider type were classified as
pediatric and all other physician visits as non-pediatric. Patients were classified as being
seen by a pediatric provider in a given year if any of their physician visits for the year
were with a provider coded as a pediatric provider. If the patient was seen exclusively
by non-pediatric providers, then they were coded as seeing non-pediatric providers. For
example, if a patient had three visits with non-pediatric providers and one with a pediatric
provider, they would be coded as being seen by a pediatric provider for that year. In addition,
patients may have had outpatient visits that were not coded as physician visits, due to being
seen by a non-physician who billed independently or seen at a facility without a physician
code being billed, for example.
Follow-Up Assessment
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Patients were included in the follow-up if they had seen a physician in the baseline year and
were continuously enrolled 3 years later, for example, 2011 baseline and 2014 follow-up. In
a sensitivity analysis, we restricted the sample to those in the 2011 baseline with continuous
enrollment for all 4 years.
J Atten Disord. Author manuscript; available in PMC 2022 December 01.Hart et al. Page 4
Outcome Assessment
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Outcomes included type of providers seen in the follow-up year and whether they had filled
at least one prescription for an ADHD medication in the follow-up year. The follow-up data
were pooled across years 2014 to 2016 stratified by ages 11–12, 13–14, 15–16, 17–18, and
19–20 years (i.e., 3 years older than at baseline).
We determined whether patients in each age group had visits with any pediatric providers
at follow-up. We then stratified these results based on whether they had visit pediatric
providers at baseline. Finally, we assessed the proportions in each age group who had at
least 1 ADHD medication prescription filled during follow-up, stratified by provider types
seen at baseline and follow-up. Patients who did not have an ADHD medication prescription
filled during follow-up were considered to have discontinued medication.
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Results
Demographics
Table 1 shows the characteristics of the MarketScan pediatric population and the analytic
sample in the baseline year. The percentage of patients meeting criteria to be included the
analytic sample (i.e., having a claim with an ADHD diagnosis code and 2 or more filled
prescriptions for ADHD medication) decreased with age (e.g., 7.5% at 8–9 years vs. 5.3%
at 16–17 years). Younger children with a physician visit were more frequently seen by a
pediatric provider (e.g., 76% at 8–9 years vs. 55% at 16–17 years).
Between 36% and 41% of each age cohort was lost between the baseline and follow-up
years (Figure 1), with attrition slightly greater among those who saw only non-pediatric
providers in the baseline year.
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Follow-Up Outcomes
Most patients who were still enrolled in the follow-up year had a physician visit that year,
ranging from 97% of those aged 11–12 years to 92% of those aged 19–20 years (Table 2a,
Figure 2). Similar to the baseline analysis, the proportion of patients who had a physician
visit with a pediatric provider during the follow-up year decreased with age, with the largest
drop-offs occurring from 15–16 years to 17–18 years (65%–47%) and from 17–18 years to
19–20 years (47% to 26%). Among those who had a physician visit with a pediatric provider
at baseline, the majority had visits with a pediatric provider at follow-up, with the exception
of those ages 19–20 years old at follow-up, of whom only 38% had visits to a pediatric
provider (Table 2b, Figure 2). Among those who had physician visits with only non-pediatric
providers at baseline, some proportion of all age groups had physician visits with a pediatric
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provider during follow-up, ranging from 49% of those ages 11–12 years to 10% of those
ages 19–20 years (Table 2c, Figure 2).
The percentage of subjects who filled prescriptions for ADHD medications in the follow-up
year decreased with increasing age, varying from 77% in the youngest cohort to 52% in the
oldest cohort (Table 3a, Figure 3). A larger proportion of those who had physician visits
with pediatric provider(s) both at baseline and follow-up continued to fill medications than
J Atten Disord. Author manuscript; available in PMC 2022 December 01.Hart et al. Page 5
those seen by a pediatric provider at baseline and only non-pediatric providers at follow-up.
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For example, in the cohort ages 15–16 at follow-up, the percentage continuing to fill
prescriptions was 71% of those who had physician visits with a pediatric provider at baseline
and follow-up. Among those who had physician visits with a pediatric provider at baseline
and only non-pediatric providers at follow-up, only 53% continued to fill prescriptions for
ADHD medication (Table 3b, Figure 3). Among those in the cohort ages 15–16 at follow-up
who had physician visits with non-pediatric providers at both baseline and follow-up, 62%
continued to fill prescriptions for ADHD medication (Table 3c, Figure 3).
Small numbers of patients had no outpatient physician visits recorded in the follow-up year.
That percentage increased with age, from 3% of those ages 11–12 to 8% of those ages 19–20
(Table 2). Between 20% and 50% of those who had no physician visit in the follow-up year
had refilled medications during the year, and this proportion decreased with increasing age
(Table 3). In a sensitivity analysis restricted to those who saw a pediatric provider in 2011
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and were continuously enrolled all 4 years, the percentages who had no physician visit in
the follow-up year who refilled prescriptions were markedly lower. The results for those who
saw physicians in the follow-up year were similar to those reported in the tables (data not
shown).
Discussion
In this study, we aimed to understand the age at which patients with ADHD stopped
medication for ADHD and to explore the role that changing from a pediatric provider to
exclusively non-pediatric providers may have played in stopping medication for ADHD.
Our analysis of private insurance claims data showed a steady drop-off in continued ADHD
medication claims in each successive age group up to 17–18 years, with an apparently more
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rapid drop-off at ages 17–18 years. This suggests that while patients with ADHD may stop
medication for ADHD at any age, around age 18 seems to be a common time for stopping
medication for ADHD.
The change from pediatric to non-pediatric providers may play a role in discontinuing
medication for ADHD, although having a physician visit with a pediatric provider at follow
up was positively associated with ADHD medication continuity independent of baseline
provider type. Patients with physician visits with a pediatric provider at both baseline and
follow-up more frequently continued ADHD medication refills than either those who had
physician visits with only non-pediatric providers at baseline and follow-up or those who
changed from physician visits with a pediatric provider at baseline to physician visits with
only non-pediatric providers at follow-up. Patients who changed from physician visits with
only non-pediatric providers at baseline to a pediatric provider at follow-up were also more
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likely to continue to fill ADHD medication prescriptions.
We cannot definitively state that provider type or change in providers is associated with
stopping ADHD medication in part because we cannot identify specific providers in
MarketScan data or link providers to prescriptions. Disparities in access may also be a
confounding factor; for example, fewer enrollees in rural areas saw pediatric providers
and specialists within each age group. Future assessments of associations and disparities
J Atten Disord. Author manuscript; available in PMC 2022 December 01.Hart et al. Page 6
in provider type, provider continuity, and medication continuity could generate useful
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information for treatment guidance and health services planning.
Understanding the role that age and change in provider play in medication continuity for
adolescents and young adults with ADHD is important because a relatively small percentage
of adolescents and young adults resume ADHD medication after a distinct period without
medication (Brinkman et al., 2018; Newlove-Delgado et al., 2019). This suggests that
disruptions in medication treatment can result in discontinuation of treatment for many
adolescents and young adults with ADHD. Our study highlights groups who are potentially
at higher risk for experiencing medication disruption (and thus for stopping medication
altogether): older adolescents, young adults, and those transitioning from pediatric to non
pediatric providers. By knowing which groups are at risk, we can better target supports
to these groups to help ensure medication continuity for them, assuming this is clinically
indicated. When discontinuation is clinically indicated, primary care providers can help
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ensure that any other needed treatments and supports continue.
Patient factors may contribute to the observed decrease in ADHD medication use with age.
The follow-up data showed that over half of patients were seeing non-pediatric practices
at ages 19–20. As a result, patients appear to be making the transition to adult care while
also navigating the stressors of adolescence and young adulthood, such as high school,
college, work, first time living independently, etc. Discontinuation in treatment may be
related to difficulties navigating the transition to adult health care at the same time as these
other challenging life events. Decrease in use of ADHD medications in this population
may also be due to lack of perceived need by patients and families. While studies have
shown that many children and adolescents with ADHD continue to have symptoms in
adulthood (Barkley et al., 2002; Biederman et al., 2010; Faraone et al., 2006; Gudjonsson
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et al., 2009; Young & Gudjonsson, 2008), patients and families may not recognize or
expect these continued symptoms or their related impairment. Others may want to try
to manage symptoms without ADHD medication. A high percentage of adolescents with
ADHD who have stopped taking medication report that they could manage without it or
that the medication was not helping; however, nearly all adolescents that stopped taking
medication still experienced at least one domain of impairment based on self or parent report
(Brinkman et al., 2018).
We found that greater than 20% of adolescents and young adults without a physician visit
during follow-up continued to fill prescriptions for ADHD medication during follow-up
despite not having a physician visit during the same calendar year. We recognize that there
are valid reasons why this may have occurred. Some of those patients may have received
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care from non-physician providers such as in college counseling centers who might have
coordinated prescriptions that might not be captured in the database. Others may have had
a prescription from the previous calendar year that was filled in the subsequent calendar
year. Some patients may have had a phone visit with their physician that was not billed
but provided enough information for the provider to send refills. Nonetheless, this finding
raises concerns that some patients may be continuing these medications without proper
monitoring for efficacy or side effects, such as headache, high blood pressure, and weight
loss, or for medication misuse, which is common in adolescents and young adults (Benson
J Atten Disord. Author manuscript; available in PMC 2022 December 01.Hart et al. Page 7
et al., 2015; Lasopa et al., 2015; McCabe et al., 2004). While factors such as being away
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at college or doing well on a stable dose may result in less frequent follow-up, the highest
proportions of patients who received ADHD medications but did not have a visit were in the
younger age groups, when guidelines recommend regular monitoring of height, weight, and
blood pressure (Wolraich et al., 2019). Future studies could explore the relationship between
continuing to fill prescriptions for ADHD medications and receipt of regular follow-up as
recommended by national practice guidelines.
This study has several limitations. First, MarketScan data come from people covered
by employer-sponsored insurance (ESI) plans, which are similar demographically to the
population with ESI in the nationally representative Medical Expenditure Panel Survey
(MEPS) sample, (Aizcorbe et al., 2012). National data show that the population with ESI
differs demographically from those with other insurance types, such as Medicaid, or no
insurance; they are more likely to be non-Hispanic White and less likely to be Black or
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Hispanic. They are also more likely to have higher incomes relative to the Federal Poverty
Level and much less likely to have a dis-ability (National Center for Health Statistics, 2016).
A further limitation is the lack of clinical information. Using claims data, we were unable
to determine the degree of ADHD symptoms for each individual or the appropriateness
of medication continuation or discontinuation. In other words, patients with resolution of
ADHD symptoms may no longer need ADHD medication and stopping medication could
represent appropriate clinical care.
Further, we opted to only include those who were continuously enrolled in either the
baseline or follow-up years, since it is not possible to accurately characterize provider
types for those with partial year enrollments, who comprise 10% to 20% of enrollees in
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a year. It is also possible that patients received care or refilled prescriptions without using
their insurance, which would not be captured in the MarketScan data, and we could not
account for the use of diverted medications (i.e., taking medication prescribed for another
individual), which studies show occurs relatively frequently (4% of middle and high school
students and 17% of college students) (Benson et al., 2015; McCabe et al., 2004).
As noted previously, we are unable to determine which provider wrote the prescriptions
and so cannot definitively show that changing providers accounted for the discontinuation
of medication. We were only able to classify provider type and were unable to determine
continuity of care from individual providers. We also did not account for the presence of
co-occurring conditions, which may influence the type of provider seen and the decision
to continue or discontinue medications. Finally, an important caveat is that the provider
type variable can refer to either an individual provider who bills independently or a
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group practice, for example, “multi-specialty practice,” which may have led to incorrect
categorization of some visits. For example, if a patient was seen by a pediatric specialist in a
“multi-specialty practice,” the patient visit would be designated as non-pediatric.
In conclusion, we found that among children and adolescents who received ADHD
medications at baseline, the percentage with prescriptions filled at follow-up appeared
to decline with age. With respect to the relationship between change in provider and
J Atten Disord. Author manuscript; available in PMC 2022 December 01.Hart et al. Page 8
medication continuation, those who saw pediatric providers at baseline and follow-up
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were more likely to be continuing medication at follow-up than those who saw pediatric
providers at baseline and non-pediatric providers at follow-up. These results suggest that
older adolescents and those making the transition from pediatric to adult care may be at
risk of discontinuing medication for ADHD. Studies show that continued treatment when
clinically indicated is associated with better function (Chang et al., 2014; Halmøy et al.,
2009; Quinn et al., 2017). This study supports recommendations for close follow-up and
monitoring of patients as they make the transition from pediatric to adult care to ensure their
medical needs are continuously met during the transition process (White & Cooley, 2018).
Our data also suggest that many patients may be getting ADHD medication refills without
regular follow-up visits with a physician or other provider. Further exploration of medication
receipt without regular physician visits could fill in this important knowledge gap, which
is important given the possibility of adverse effects and concerns about misuse of ADHD
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medications.
Supplementary Material
Refer to Web version on PubMed Central for supplementary material.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Author Biographies
Laura C. Hart is an assistant professor of pediatrics at Nationwide Children’s Hospital and
The Ohio State University College of Medicine and adjunct assistant professor of medicine
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at The Ohio State University College of Medicine. Her research focus is the transition from
pediatric to adult care for adolescents and young adults with chronic illness, particularly for
adolescents and young adults with intellectual and developmental disabilities.
Scott D. Grosse is Research Economist in the National Center on Birth Defects and
Developmental Disabilities, Centers for Disease Control and Prevention. He conducts health
services, outcomes and economic research on a wide range of congenital, genetic, and
neurodevelopmental conditions and associated interventions or health policies.
Melissa L. Danielson is a statistician with the Child Development Studies Team in the
National Center on Birth Defects and Developmental Disabilities, Centers for Disease
Control and Prevention (CDC). Her work focuses on the epidemiology of ADHD and other
mental, emotional, and behavioral disorders among children, including work on disorder
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prevalence, clinical presentation, service utilization, and outcomes for children diagnosed
with these disorders.
Rebecca A. Baum is a developmental behavioral pediatrician and clinical associate
professor of pediatrics at Nationwide Children’s Hospital and the Ohio State University
College of Medicine. Her research focuses on the implementation of evidence-based mental
health care in the primary care setting.
J Atten Disord. Author manuscript; available in PMC 2022 December 01.Hart et al. Page 9
Alex R. Kemper is professor and Division Chief of Primary Care Pediatrics at Nationwide
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Children’s Hospital and the Ohio State University College of Medicine. His research focuses
on a wide array of preventive services delivered in the primary care setting.
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attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 144(4), e20192528.
10.1542/peds.2019-2528 [PubMed: 31570648]
Young S, & Gudjonsson GH (2008). Growing out of ADHD: The relationship between functioning
and symptoms. Journal of Attention Disorders, 12(2), 162–169. 10.1177/1087054707299598
[PubMed: 17494827]
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Figure 1.
Analytic sample size at baseline and follow-up by age cohort and provider type.
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J Atten Disord. Author manuscript; available in PMC 2022 December 01.Hart et al. Page 12
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Figure 2.
Distribution of provider types seen by adolescent and young adult patients during follow-up
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year.
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J Atten Disord. Author manuscript; available in PMC 2022 December 01.Hart et al. Page 13
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Figure 3.
Proportion of patients getting ≥2 refills of ADHD medications during follow-up year.
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Table 1.
Patient Characteristics Within the Baseline Year (Pooled, Years 2011–2013).
Age 8–9 years n (%) Age 10–11 years n (%) Age 12–13 years n (%) Age 14–15 years n (%) Age 16–17 years n (%)
Hart et al.
Patients with continuous coverage and any outpatient encounters 1,257,321 1,342,464 1,373,816 1,419,023 1,465,922
a 93,956 (7.5) 101,135 (7.5) 96,055 (7.0) 88,535 (6.2) 78,082 (5.3)
ADHD diagnosis & 2+ filled prescriptions of ADHD medications
b 91,292 (97) 98,434 (97) 93,385 (97) 86,160 (97) 75,848 (97)
Any physician visit
c 69,609 (76) 72,837 (74) 65,669 (70) 55,738 (65) 42,030 (55)
Physician visit with any pediatric provider
Note. All subjects were continuously enrolled in MarketScan Commercial employer-sponsored insurance plans with prescription drug coverage during the baseline calendar year and had outpatient claims.
Children with attention ADHD had ≥1 ADHD diagnosis code and ≥2 claims for ADHD medications in the calendar year.
a
Percentages shown here are the medication treated current-year prevalence of ADHD in the age group in the baseline year.
b
Percentages shown here are the percentages of those with current-year medication treated ADHD who had a claim associated with an office visit of any physician provider type.
c
Percentages shown here are the percentages of those with any physician visit who saw a pediatric provider.
J Atten Disord. Author manuscript; available in PMC 2022 December 01.
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Table 2.
Distribution of Provider Types Seen by Adolescent and Young Adult Patients During the Follow-Up Year (Pooled, Years 2014–2016).
Physician visit with a pediatric Physician visit with non-pediatric
Hart et al.
Enrolled at follow-up with No physician visits during
Age at baseline (years) Age at follow-up (years) provider during follow-up n providers during at follow-up n
outpatient visits N c
a b follow-up n (%)
(%) (%)
(a) Those who had a physician visit with any provider (pediatric or non-pediatric) at baseline.
8–9 11–12 59,538 45,790 (77) 12,106 (20) 1,642 (3)
10–11 13–14 64,703 46,382 (72) 16,031 (25) 2,290 (4)
12–13 15–16 61,401 39,616 (65) 19,012 (31) 2,613 (4)
14–15 17–18 55,454 26,225 (47) 25,753 (46) 3,476 (6)
16–17 19–20 46,266 11,826 (26) 30,758 (66) 3,682 (8)
(b) Those who had a physician visit with a pediatric provider visit at baseline.
8–9 11–12 42,416 37,442 (88) 4,045 (10) 929 (2)
10–11 13–14 44,750 38,043 (85) 5,849 (13) 1,276 (3)
12–13 15–16 41,210 32,469 (79) 7,145 (17) 1,446 (4)
14–15 17–18 34,802 21,678 (62) 11,282 (32) 1,842 (5)
16–17 19–20 25,847 9,755 (38) 14,269 (55) 1,823 (7)
(c) Those who had a physician visit with only non-pediatric provider visits at baseline.
8–9 11–12 17,122 8,348 (49) 8,061 (47) 713 (4)
10–11 13–14 19,535 8,339 (43) 10,182 (52) 1,014 (5)
12–13 15–16 20,191 7,147 (35) 11,877 (59) 1,167 (6)
14–15 17–18 20,652 4,547 (22) 14,471 (70) 1,634 (8)
16–17 19–20 20,419 2,071 (10) 16,489 (81) 1,859 (9)
J Atten Disord. Author manuscript; available in PMC 2022 December 01.
Note. All subjects were continuously enrolled in MarketScan Commercial employer-sponsored insurance plans with prescription drug coverage during the baseline calendar year and follow-up year.
Analyzes were stratified by type of provider seen at baseline.
a
Percentages in this column show the percentage of patients in a given age group who saw a pediatric provider among those who had a visit in that age group.
b
Percentages in this column show the percentage of patients in a given age group who saw only non-pediatric providers among those who had a visit in that age group.
c
Percentages in this column show the percentage of patients in a given age group who had no physician visits among those who had a visit in that age group.
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Table 3.
Proportion of Patients Getting ≥2 Refills of ADHD Medications During Follow-Up Year (Pooled, Years 2014–2016).
Filled ADHD medications Filled ADHD medications
Hart et al.
Filled ADHD medications during follow-up among those during follow-up among those Filled ADHD medications
during follow-up among those who had a physician visit with who had physician visits with during follow-up among those
Age at follow-up with outpatient visits during a pediatric provider during only non-pediatric providers with no physician visits during
Age at baseline (years) (years) follow-up n (%) follow-up n (%) during follow-up n (%) follow-up n (%)
(a) Those who saw any provider at baseline.
8–9 11–12 45,995 (77) 36,400 (79) 8,766 (72) 829 (50)
10–11 13–14 46,255 (71) 34,700 (75) 10,535 (66) 1,020 (45)
12–13 15–16 40,123 (66) 28,042 (71) 11,117 (58) 964 (37)
14–15 17–18 30,993 (56) 17,085 (65) 12,892 (50) 1,016 (29)
16–17 19–20 24,176 (52) 7,889 (67) 15,234 (50) 1,053 (29)
(b) Those who saw pediatric providers at baseline.
8–9 11–12 33,088 (78) 29,857 (80) 2,780 (69) 451 (49)
10–11 13–14 32,734 (72) 28,619 (75) 3,545 (61) 570 (45)
12–13 15–16 27,500 (67) 23,617 (71) 3,805 (53) 528 (37)
14–15 17–18 20,100 (58) 14,228 (66) 5,435 (47) 527 (29)
16–17 19–20 14,063 (54) 6,502 (67) 7,054 (49) 507 (28)
(c) Those who saw only non-pediatric providers at baseline.
8–9 11–12 12,907 (75) 6,543 (78) 5,986 (74) 378 (53)
10–11 13–14 13,529 (69) 6,081 (73) 6,990 (69) 450 (44)
12–13 15–16 12,623 (63) 4,875 (68) 7,312 (62) 436 (37)
14–15 17–18 10,893 (53) 2,857 (63) 7,547 (52) 489 (30)
16–17 19–20 10,113 (50) 1,387 (67) 8,180 (50) 546 (29)
J Atten Disord. Author manuscript; available in PMC 2022 December 01.
Note. All subjects were continuously enrolled in MarketScan Commercial employer-sponsored insurance plans with prescription drug coverage during the baseline calendar year and follow-up year.
Analyzes were stratified by type of provider seen at baseline.
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